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The principle of triage is one of the cardinal rules of emergency medicine. Medical staff faced with multiple patients assess the urgency of the wounds and illnesses in front of them to decide who needs help immediately and who can afford to wait.

Trouble breathing? That’s a surefire way to the top of the list. Injured ankle? Yes it hurts, but you can expect to log some time in the waiting room.

It is useful to consider the triage process when thinking about the state of Edmonton’s health-care facilities. The city has two hospitals — the Royal Alexandra Hospital in central Edmonton and the Misericordia Community Hospital in the west end — that belong at the front of the queue by almost every measure imaginable.

Both facilities, built in the 1960s, are in critical condition. Each have multiple, well-documented infrastructure problems accumulated over years of neglect. An Alberta Health Services assessment in 2015 identified a massive overhaul of the Royal Alex as its No. 1 infrastructure priority in the province, with the Misericordia coming immediately behind it at No. 2.

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But just as in the ER, where patient symptoms are routinely reassessed, AHS appears to be in the midst of a rethink about where a new (or dramatically refurbished) Misericordia should fall in its construction priority queue. An AHS report obtained by Journal health reporter Keith Gerein suggests the Misericordia’s lifespan could be prolonged by as much as 20 to 30 years with a smaller, less costly “modernization.”

The assessment seems extremely optimistic given the hospital’s history of infrastructure problems. Just nine months ago, health officials were advocating for a $2.5-billion overhaul that would have at least doubled its 300-bed capacity. Somehow the Misericordia has gone from “trouble breathing” to “injured ankle” without the doctor doing a thing.

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There is little argument about the Royal Alex’s place at the top of the triage list. There is a pressing need to replace its overcrowded core, despite the $2 billion price tag that comes with the initial phases of the project. The hospital is one of northern Alberta’s key medical hubs. Statistics from 2015 showed the facility handled about 13 per cent of all ICU cases in Alberta, 13 per cent of all surgeries and 11 per cent of all births. That is a lot of traffic in a province of more than four million people.

But despite the many infrastructure plans, there is still no word from the provincial government on how much money will be available to meet Edmonton’s needs. Will it approve a replacement plan for the Royal Alex? For the Misericordia? Or will it bite on AHS’ suggestion for a new hospital in an as yet to be determined location in suburban Edmonton?

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It is time for some answers before triage becomes pointless.

Alberta cannot let its hospitals fall into a state of greater disrepair as it prays for the return of $100 oil. The problems, and the bills, will only multiply. That’s worth mentioning because, as much as critics accuse the NDP of being spendthrift, early signals coming from Rachel Notley’s government are that the next budget will be built on the message of restraint.

The band-aid approach to Edmonton’s hospital infrastructure over the last several decades got us where we are today. It’s not good enough. The Royal Alex and Misericordia hospitals need funded action plans now.

Editorials are the consensus opinion of the Journal’s editorial board, comprising Mark Iype, Dave Breakenridge, Sarah O’Donnell and David Evans.

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